Face Lift

FACE LIFT

Rhytidectomy (ie, face lift) is a surgical procedure that removes soft tissue folds and minimizes cutaneous wrinkles on the face. It is performed to create a more youthful appearance.

Psychological preparation requires that the patient recognize the limitations of surgery and the fact that miraculous rejuvena-tion will not occur. The patient is informed that the face may ap-pear bruised and swollen after the dressings are removed and that several weeks may pass before the edema subsides.

The procedure is performed under local or general anesthesia, often in the outpatient setting. The incisions are concealed in natural skin folds and creases and areas hidden by hair. The loose skin, separated from underlying muscle, is pulled upward and backward. Excess skin that overlaps the incision line is removed. Liposuction-assisted rhytidectomy is being performed more frequently. In this procedure, fat is suctioned from the body through a cannula inserted through a small incision.

Management

The nurse encourages the patient to rest quietly for the first 2 post-operative days until the dressings are removed. The head of the bed is elevated, and neck flexion is discouraged to avoid compro-mising the circulation and the suture line. The patient may feel some tightness of the face and neck from pressure created by the newly tightened muscles, fascia, and skin. Analgesics may be pre-scribed to relieve discomfort. A liquid diet may be given by means of straws, and a soft diet is permitted if chewing is not too un-comfortable.

When the dressings are removed, the skin is gently cleaned of crusting and oozing and coated with the prescribed topical oint-ment. Any hair matted with drainage may be combed with warm water and a wide-toothed comb.

The patient is advised not to lift or bend for 7 to 10 days be-cause this activity may increase edema and provoke bleeding. Ac-tivities are gradually resumed. When all sutures are removed, the hair may be shampooed and blown dry with warm, not hot, air to avoid burning the ears, which may be numb for a while.

The patient needs to know that a face lift will not stop the aging process and that, with time, the tissues will resume the downward drift. Some patients have two or more face lifts.

Sudden pain indicates that blood is accumulating under-neath the skin flaps; it should be reported to the surgeon immediately. Complications include sloughing of the skin, deformities of the face and neck, and partial facial paralysis. Cigarette smoking has been implicated as a cause of skin slough in some patients.